Journal of the Royal College of Physicians of Edinburgh最新文献

{"title":"Lessons from the Royal College of Physicians of Edinburgh's trainee-led medical education podcasts.","authors":"Christopher J Graham, Natasha J Armstrong, Charlotte Holmes, Perrin Grant, Jonathan Bardgett, Anda Bularga, Hannah Preston, Katherine Ralston, Marilena Giannoudi","doi":"10.1177/14782715251380002","DOIUrl":"10.1177/14782715251380002","url":null,"abstract":"<p><p>Medical education podcasts are increasingly popular, providing high-quality, asynchronous education to listeners. Here, we describe our experience developing the Royal College of Physicians of Edinburgh (RCPE)'s trainee-led podcasts, <i>Clinical Conversations</i> and <i>Career Conversations</i>. Both podcasts have been designed by resident doctors for resident doctors and are in high demand, approaching one-quarter of a million plays and international listenership. In this article, we explore the myriad benefits for resident doctor hosts, guest speakers and staff involved in podcast production, as well as reflecting on the challenges faced. Providing free, high-quality medical education is a core purpose of RCPE to benefit patients, physicians and healthcare systems around the world, and podcasts play a key role in this. By openly sharing our achievements, challenges and lessons learnt during our journey, we hope we may inspire others to engage in creating high-quality, accessible medical education.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"307-313"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'First do no harm': Does the Hippocratic Oath and its medical principles still have a role in today's medicine?","authors":"Marilena Giannoudi, Carl Lv Simela, Nana Su Oteng-Attakora, Ella K Banbury, Lauren Rm Jones, Rebecca C Sagar","doi":"10.1177/14782715251382978","DOIUrl":"10.1177/14782715251382978","url":null,"abstract":"<p><p>The Hippocratic Oath, written by the father of medicine, Hippocrates in 430 BCE has been sworn for millennia across the world by new doctors. Its nine articles outline how a doctor must treat their patients effectively, abiding by the core ethical principles that underscore Good Medical Practice today, including a focus on beneficence and non-maleficence. Today, the Gods of Olympus are no longer routinely worshipped, and we benefit from vast medical and technological advances, so the question arises whether the principles of Hippocratic medicine are still relevant? On the island of Kos, Hippocrates' birthplace, there continues the tradition of an annual 'oath swearing' ceremony for students that have completed medical school both from Greece and across the world. Whilst this event can be used to celebrate the achievements of the new doctors in training, is there still a need for them to retrace the routes of the profession? This article aims to explore the core principles of the Oath and Hippocratic medicine and determine their relevance in today's modern society.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"302-306"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Primum non nocere' - The old lie?","authors":"Tim Cassidy","doi":"10.1177/14782715251374900","DOIUrl":"10.1177/14782715251374900","url":null,"abstract":"<p><p>Harm occurs in 10% of hospitalised patients. After 20 years of patient safety implantation plans using a Safety 1 paradigm, developed from high-risk industries, there has been no significant change, except in certain niche areas. Hospital medicine has changed over the last two decades; we now work in an intractable system. The Safety 2 paradigm looks at how things go right (90% of times) so often. Clinicians are able to adjust their work to conditions (work as done) and adapt to changing conditions. Therefore, the way forward, is a combination of these two paradigms. It is still the case that some of these adverse events are relatively simple or can be treated as relatively simple without serious consequences. Using a Safety 1 paradigm will therefore be appropriate. But there is a growing number of cases where this approach will not work. In these instances, it is necessary to adopt a Safety 2 view.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"344-346"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and preliminary validation of a cognitive-physical frailty index in an older adult cohort: The NEDICES study.","authors":"Carlos Felipe Rengifo Rodas, Félix Bermejo-Pareja, Jesús López-Arrieta, Julián Benito-León","doi":"10.1177/14782715251369601","DOIUrl":"10.1177/14782715251369601","url":null,"abstract":"<p><strong>Background: </strong>Frailty is a multidimensional syndrome characterised by reduced physiological reserve and increased vulnerability to adverse health outcomes. While traditional frailty models focus primarily on physical decline, emerging evidence supports the integration of cognitive domains for a more comprehensive assessment. We wished to develop and preliminarily validate a cognitive-physical frailty index using data from a large, prospective population-based cohort of older adults in central Spain.</p><p><strong>Methods: </strong>We constructed a frailty index based on 12 variables spanning physical, cognitive, subjective, and functional domains. These were selected from the Neurological Disorders in Central Spain (NEDICES) study using criteria based on feasibility, clinical relevance, and prior evidence of mortality prediction. Frailty distributions and transitions were analysed between two time points (1994-1995 and 1997-1998), and mortality risk was assessed using Cox proportional hazards models.</p><p><strong>Results: </strong>Among the 5,278 participants, the frailty distribution shifted to the right over the 3-year follow-up period, reflecting an increasing vulnerability. The frailty index demonstrated a strong association with all-cause mortality (hazard ratio = 28.05; 95% CI: 16.37-48.06). Quartile-based stratification illustrated clearly within-sample progression. The index showed high goodness-of-fit under a gamma distribution, supporting its internal coherence.</p><p><strong>Conclusion: </strong>This brief, multidimensional frailty index offers a feasible tool for capturing early cognitive and physical decline and predicting short-term mortality in ageing populations. Although preliminary, these findings underscore the value of integrating cognitive indicators into frailty assessment. Future validation in other cohorts and with long-term data is warranted.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"250-261"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erdheim-Chester disease: A multisystem non-Langerhans cell histiocytosis with cutaneous involvement.","authors":"Neetu Bhari, Ritu Sharma, Sushant Agrawal, Vishal Gaurav","doi":"10.1177/14782715251394933","DOIUrl":"10.1177/14782715251394933","url":null,"abstract":"<p><p>Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis (LCH) marked by systemic involvement and diverse clinical manifestations. We report a 35-year-old man with yellowish-brown periorbital lesions initially diagnosed as xanthelasma, which later recurred. The patient developed neurological symptoms, including proximal lower limb weakness and cranial nerve palsies, which improved with corticosteroids. Imaging revealed retro-orbital masses, pan-rhinosinusitis and extensive sclerosis of the sinonasal cavity, along with systemic organ involvement, including the kidneys and spine. Histopathology demonstrated foamy histiocyte infiltration, positive for CD163 and CD68 but negative for S100. The BRAF V600E (B-raf proto-oncogene valine-to-glutamic acid substitution at position 600) mutation was absent. A multidisciplinary team initiated the LCH III protocol, leading to partial regression of cutaneous lesions and stabilisation of neurological symptoms. This case highlights the importance of recognising atypical ECD presentations and suggests the LCH III protocol may benefit BRAF-negative cases. Multidisciplinary management is critical given the disease's progressive, multisystem nature.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"286-291"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical lead in medicine and co-lead at Medical School: Reflections from transitioning through the RCP Chief Registrar programme within the NHS.","authors":"Sushuma Kalidindi","doi":"10.1177/14782715251372408","DOIUrl":"10.1177/14782715251372408","url":null,"abstract":"<p><p>The Royal College of Physicians flagship chief registrar programme, an initiative launched nearly a decade ago was an innovative leadership and management programme for medical registrars which has now been rolled out to other specialties as well. The role has evolved over time and explores the broader aspects of the ways of workings in the UK National Health Service, the progression and impact for individuals, teams and organisations across the wider health economy both from the perspective of acute care as well as treating long-term conditions. A personal reflection on connecting the experiential learning attained from being a chief registrar and transitioning through this unique and distinctive programme towards embedding into the Consultant Physician job that encompasses broadening horizons into non-clinical managerial domains such as Clinical Lead from a service line perspective as well as academic Co-lead to widen the landscape of undergraduate medical school placements is illustrated in this article.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"339-343"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical appraisal of an original research article.","authors":"Sham Santhanam, Vinod Ravindran, Chris Wincup","doi":"10.1177/14782715251369964","DOIUrl":"10.1177/14782715251369964","url":null,"abstract":"<p><p>Critical appraisal of evidence involves carefully evaluating a study's validity, reliability, applicability and generalisability. It is essential for all clinicians and those involved in academic publishing. A manuscript must adhere to two sets of standards. First, reporting guidelines ensure uniformity, transparency and clarity. Then, critical appraisal tools or criteria assess the study's methodological robustness. The manuscript may undergo a preliminary screening before we initiate the critical appraisal process. The foremost criterion is evaluating the journal's quality, assessing the study topic, design and sample size, and checking if the study objectives and outcome measures have been clearly stated. An original study is typically presented in the standard 'IMRaD' format, with each section addressing a specific set of questions. The primary purpose of the 'Introduction' section is to justify the study's objective. The 'Methods' section is crucial to the manuscript. It aids in assessing the validity of the research, describes the critical parameters in a study protocol and ensures the study's replicability. The main components covered in the 'Methods' section include the study question, design, population, sample size, outcome measures, statistical analysis and details of ethics approval. The 'Results' section should discuss the study's findings, which are outlined in the objectives. The 'Discussion' section covers the implications of the study, which should be balanced, and the interpretation in this section should align with the reported results. The validity of a study is nothing but its closeness to the truth, that is, the extent to which the results are accurate and free from bias. Hence, minimising this chance of bias in a study makes it more valid. Internal validity generally reflects a study's methodological robustness, and external validity reflects the generalisability or applicability. In this era of evidence-based medicine, critical appraisal becomes necessary as people always discuss practising it in their daily clinical practice.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"347-357"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Junior doctor medical conferences in the post-Covid era: A mixed-methods study.","authors":"Marilena Giannoudi, Paul Crampton, Amaya Ellawala","doi":"10.1177/14782715251389277","DOIUrl":"10.1177/14782715251389277","url":null,"abstract":"<p><strong>Background: </strong>Resident doctors require professional development through conference attendance yet there are major challenges to the ways in which attendance is impacted. The COVID-19 pandemic created a shift in education delivery, including medical conferences moving towards online setting. The aim of the study was to explore the factors influencing conference attendance and the post-COVID-19 implications for the future of conference delivery and professional development.</p><p><strong>Methods: </strong>A mixed-methods approach comprising of an online questionnaire and semi-structured interviews was used. Theoretical sampling was performed to invite UK-based resident doctors to complete the questionnaire. Individuals were then invited to a semi-structured interview to explore their experiences further. Content analysis was performed for questionnaire data and thematic analysis for interview data.</p><p><strong>Results: </strong>Seventy-four doctors completed the questionnaire, of these 15 participated in semi-structured interviews. During the COVID-19 pandemic most trainees attended online events, but with the abolition of travel restrictions all were keen to return to the face-to-face format. Motivational learning promoted the drive for conference attendance. Other factors included networking and the attainment of continuous professional development points.</p><p><strong>Discussion: </strong>The findings demonstrate how professional development can be successfully enacted through changes to the delivery of conferences. Virtual conferences promote inclusivity and accessibility for doctors in training. However, the lack of opportunities to network is their main drawback. Whilst face-to-face conferences are considered the most attractive; concerns regarding cost, leave, sustainability and work-life balance affect motivation to attend. The findings have implications for educators, resident doctors and conference organisers.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"262-270"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tocilizumab vs bevacizumab in critically ill COVID-19 patients: Registry-based prospective study.","authors":"Yatendra Kumar Gupta, Raghubir S Khedar, Gulam Mateen Parihar, Anil Kumar Sharma, Pramod Sarwa, Rajeev Gupta","doi":"10.1177/14782715251394935","DOIUrl":"10.1177/14782715251394935","url":null,"abstract":"<p><strong>Background: </strong>Tocilizumab, an interleukin-6 (IL-6) inhibitor, and bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, have been used in critically ill COVID-19 patients for cytokine storm. We performed a registry-based prospective study to compare the efficacy of these two drugs.</p><p><strong>Methods: </strong>Virologically confirmed hospitalised patients with severe COVID-19 who received either tocilizumab or bevacizumab have been included. Management details and outcomes were recorded. The primary outcome was in-hospital deaths and secondary outcomes were 30-day deaths, changes in oxygen requirement at 48 h of drug administration and duration of intensive care unit stay. Descriptive statistics are reported.</p><p><strong>Results: </strong>One thousand three hundred forty-five COVID-19 patients were hospitalised during the study period, 87 with severe COVID-19 received tocilizumab (<i>n</i> = 62) or bevacizumab (<i>n</i> = 25). Patients in the tocilizumab group were older (62.6 ± 11 vs 53.2 ± 14, <i>p</i> = 0.001) with more cardiovascular disease and no significant differences in clinical features, laboratory investigations, or radiological and biochemical markers of disease severity. Oxygenation, ventilatory support and proning were similar as were supportive therapies (steroids, remdesivir, anticoagulants; <i>p</i> > 0.05). In-hospital deaths in tocilizumab vs bevacizumab group were 47 (75.8%) vs 12 (48.0%; <i>p</i> = 0.012) with unadjusted hazard ratio (HR) 1.91 (95% confidence interval (CI) 0.99-3.65, <i>p</i> = 0.050) and age-adjusted HR 1.76 (95% CI 0.90-3.44, <i>p</i> = 0.097). Secondary outcome of 30-day death was also more in tocilizumab group: 49 (79.0%) vs 13 (52.0%; <i>p</i> = 0.011). Within-group comparison showed that PaO₂:FiO₂ at 48-h of drug administration was better in bevacizumab group (<i>p</i> = 0.003) compared to tocilizumab (<i>p</i> = 0.651).</p><p><strong>Conclusion: </strong>VEGF inhibitor bevacizumab led to significantly better ventilatory outcomes and lower in-hospital and 30-day deaths compared to IL-6 inhibitor tocilizumab in severely ill COVID-19 patients. Randomised studies are required to confirm these findings.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"271-277"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joyce Grainger Learning Centre.","authors":"","doi":"10.1177/14782715251403322","DOIUrl":"10.1177/14782715251403322","url":null,"abstract":"","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"363"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}